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5. Noninvasive predictors of perioperative atrial arrhythmias in patients with tetralogy of Fallot undergoing pulmonary valve replacement.

Author

Cortez, Daniel, Barham, Waseem, Ruckdeschel, Emily, Sharma, Nandita, McCanta, Anthony, von Alvensleben, Johannes, Sauer, William, Collins, Kathryn, Kay, Joseph, Patel, Sonali, and Nguyen, Duy

Subjects
Atrial Flutter, Intra-atrial Re-entrant Tachycardia, Tetralogy of Fallot, Vectorcardiography, Adolescent, Adult, Atrial Flutter, Child, Electrocardiography, Ambulatory, Electrophysiologic Techniques, Cardiac, Exercise Test, Female, Heart Valve Prosthesis Implantation, Humans, Logistic Models, Male, Multivariate Analysis, Odds Ratio, Perioperative Period, Pulmonary Valve, Retrospective Studies, Risk Factors, Tachycardia, Reciprocating, Tetralogy of Fallot, Time Factors, Treatment Outcome, Young Adult
Abstract

BACKGROUND: Patients with tetralogy of Fallot (TOF) have increased risk of atrial arrhythmias. HYPOTHESIS: A measure of atrial dispersion, the P-wave vector magnitude (Pvm), can identify patients at risk for perioperative atrial flutter (AFL) or intra-atrial re-entrant tachycardia (IART) in a large TOF cohort. METHODS: We performed a blinded, retrospective analysis of 158 TOF patients undergoing pulmonary valve replacement between 1997 and 2015. History of AFL/IART was documented using electrocardiogram, Holter monitor, exercise stress test, implanted cardiac device, and electrophysiology study. P-R intervals, Pvm, QRS duration, and QRS vector magnitude were assessed from resting sinus-rhythm 12-lead electrocardiograms and identification of those with AFL/IART was determined. RESULTS: Fourteen patients (8.9%) were found to have AFL/IART. Pvm, QRS duration, and QRS vector magnitude significantly differentiated those with AFL/IART from those without on univariate analysis: 0.09 ± 0.04 vs 0.18 ± 0.07 mV, 161.3 ± 21.9 vs 137.7 ± 31.4 ms, and 1.2 (interquartile range, 1.0-1.2) vs 1.6 mV (1.0-2.3), respectively (P < 0.05 for each). The Pvm had the highest area under the ROC curve (0.88) and was the only significant predictor on multivariate analysis, with odds ratio of 0.02 (95% confidence interval: 0.01-0.53). P-R duration, MRI volumes, and right-heart hemodynamics did not significantly differentiate those with vs those without AFL/IART. CONCLUSIONS: In TOF patients undergoing pulmonary valve replacement, Pvm has significant value in predicting those with perioperative AFL/IART. These clinical features may help further evaluate TOF patients at risk for perioperative atrial arrhythmias. Prospective studies are warranted.

Published
2017

6. Subcutaneous Implantable Cardioverter-Defibrillators in Pediatrics and Congenital Heart Disease: A Pediatric and Congenital Electrophysiology Society Multicenter Review

Author

von Alvensleben, Johannes C., Dechert, Brynn, Bradley, David J., Fish, Frank A., Moore, Jeremy P., Pilcher, Thomas A., Escudero, Carolina, Ceresnak, Scott R., Kwok, Sit Yee, Balaji, Seshadri, Aziz, Peter F., Papagiannis, John, Cortez, Daniel, Garnreiter, Jason, Kean, Adam, Schäfer, Michal, and Collins, Kathryn K.

Published
2020
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12. RECURRENT BACTEREMIA DUE TO RARE COMPLICATION OF LEAD EXTRACTION: INSULATION SHEATH RETENTION

Author

Adewumi, Joseph, primary, Sabzwari, Syed Rafay Ali, additional, Cerbin, Lukasz Patrick, additional, Barrett, Christopher, additional, Garg, Lohit, additional, Sandhu, Amneet, additional, Tumolo, Alexis Z., additional, Rosenberg, Michael, additional, West, John Jason, additional, Varosy, Paul D., additional, Tzou, Wendy S., additional, Mitchell, Max B., additional, Aftab, Muhammad, additional, von Alvensleben, Johannes, additional, Aleong, Ryan G., additional, and Zipse, Matthew Michael, additional

Published
2023
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26. Novel measures of left ventricular electromechanical discoordination predict clinical outcomes in children with pulmonary arterial hypertension

Author

Frank, Benjamin S., primary, Schäfer, Michal, additional, Douwes, Johannes M., additional, Ivy, D. Dunbar, additional, Abman, Steven H., additional, Davidson, Jesse A., additional, Burzlaff, Sandra, additional, Mitchell, Max B., additional, Morgan, Gareth J., additional, Browne, Lorna P., additional, Barker, Alex J., additional, Truong, Uyen, additional, and von Alvensleben, Johannes C., additional

Published
2020
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30. Predictors of electrocardiographic screening failure for the subcutaneous implantable cardioverter-defibrillator in children: A prospective multicenter study

Author

Campbell, Matthew, Moore, Jeremy P., Sreeram, Narayanswami, von Alvensleben, Johannes C., Shah, Anjan, Batra, Anjan, Law, Ian, Sanatani, Shubhayan, Thomas, Vincent, Nik-Ahd, Farnoosh, Williams, Stephen, Nosavan, Nina, Maldonado, Jennifer, Hart, Amelia, Balaji, Seshadri, Campbell, Matthew, Moore, Jeremy P., Sreeram, Narayanswami, von Alvensleben, Johannes C., Shah, Anjan, Batra, Anjan, Law, Ian, Sanatani, Shubhayan, Thomas, Vincent, Nik-Ahd, Farnoosh, Williams, Stephen, Nosavan, Nina, Maldonado, Jennifer, Hart, Amelia, and Balaji, Seshadri

Abstract

BACKGROUND Subcutaneous implantable cardioverter-defibrillator (SICD) shows promise for select patients at risk of sudden cardiac death. However, patients need to pass an electrocardiographic (ECG) screening (ECG-S) test before they can receive an SICD. Predictors of ECG-S failure in children are unclear. OBJECTIVE The purpose of this study was to identify the incidence and predictive factors for failure of ECG-S in children. METHODS Patients 18 years and younger with a preexisting ICD underwent ECG-S for SICD. ECG and demographic data were analyzed for factors predictive of failure. RESULTS Seventy-three patients (mean age 14.2 +/- 3.3 years; range 5-18 years) with hypertrophic cardiomyopathy (n = 24, 33%), long QT syndrome (n =18, 25%), other inherited arrhythmia syndromes (n = 20, 27%), congenital heart disease (n = 9, 12%), and miscellaneous conditions (n = 2) with an existing transvenous ICD underwent prospective ECG-S. Nineteen (26%) failed ECG-S. Failed patients had a longer corrected QT (QTc) interval (457 ms vs 425 ms; P = .03), a longer QRS duration (120 ms vs 98 ms; P = .04), and a lower ratio of R-wave to T-wave amplitudes (R:T ratio) in lead aVF (4 vs 5; P = .001). Multivariable logistic regression identified QTc interval (odds ratio [OR] 4.31; P = .04), QRS duration (OR 4.93; P = .03), R:T ratio in lead aVF (OR 3.13; P = .08) as predictors of failure. A risk score with 1 point each for QTc interval >440 ms, QRS duration >120 ms, and R:T ratio <6.5 in lead aVF was associated with probability of failure of 15.4% (1 point), 47.4 0 /. (2 points), and 88.6% (3 points), respectively. CONCLUSION ECG-S failure for SICD occurred in 26% of children, which is higher than the reported incidence in adults. Factors predicting ECG-S failure included longer QTc interval, longer QRS duration, and lower R:T ratio in lead aVF.

Published
2018

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